Reading of the Week: What Can Past Coronaviruses Teach Us? Also, Sharing Notes (Lancet Psych) & Sediqzadah on Therapy in a Digital World (Globe)

From the Editor

As we consider the psychiatric needs arising from COVID-19, are there lessons to be drawn from past severe coronavirus infections?

The first selection seeks to answer that question.

In The Lancet Psychiatry, Dr. Jonathan P. Rogers (of the University College London) and his co-authors do a systematic review and meta-analysis of severe coronavirus infections with a focus on psychiatric presentations. They included papers covering SARS and MERS. “This review suggests, first, that most people do not suffer from a psychiatric disorder following coronavirus infection, and second, that so far there is little to suggest that common neuropsychiatric complications beyond short-term delirium are a feature.”

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Should mental health notes be shared with patients? In the second selection, we look at paper from The Lancet Psychiatry. Charlotte R. Blease (of Harvard Medical School) and her co-authors champion the idea. “Sharing clinical notes in mental health settings will be more complex than in other clinical specialties; however, for most patients it will be feasible and, if carefully implemented, an empowering tool that could improve care.”

Finally, we consider an essay from The Globe and Mail. Dr. Saadia Sediqzadah (of the University of Toronto), who is graduating from her psychiatry residency this month, discusses her training and the expectation that patients “present to the clinic.” Now practicing in a COVID-19 world, she writes about psychotherapy and her patients. “What would Freud say? I care less about that as we now contend with a very different world than his. The question I ask now is, how will we go back?”

DG

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“Not normal is the new normal”: How does the pandemic impact mental health treatment? We asked a CAMH psychiatrist

I’m grateful for the opportunity to have talked with Liza Agrba of Toronto Life about COVID-19 and mental health.

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The full interview can be found here:

https://torontolife.com/city/life/not-normal-is-the-new-normal-how-does-the-pandemic-impact-mental-health-treatment-we-asked-a-camh-psychiatrist/

 

Reading of the Week: How to Achieve Good Mental Health During Isolation (BJP)? Also, Bipolar Meds (AJP) & Qayyum on the Way to the Morgue (WBUR)

From the Editor

Millions of people are isolating themselves in North America, and across the world. We know that quarantine is linked to mental health problems like depression. So what advice should we be giving our patients – and our family and neighbours?

The first selection seeks to answer this question.

In The British Journal of Psychiatry, Rowan Diamond (of Warneford Hospital) and Dr. John Willan (of Oxford University Hospitals NHS Foundation Trust) provide six suggestions, drawing from the literature and taking into account our collective situation. “Dame Vera Lynn, at the age of 103, said of this pandemic that ‘even if we’re isolated in person we can still be united in spirit,’ and the sense of purpose that may be engendered in self-isolation may paradoxically lead to improvements in the mental health of some individuals who may otherwise feel that they have lost their role in society.”

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How are we managing bipolar affective disorder? In the second selection, we look at a new American Journal of Psychiatry paper by Taeho Greg Rhee (of the University of Connecticut) and his co-authors, who draw on 20 years worth of data. “There has been a substantial increase in the use of second-generation antipsychotics in the outpatient psychiatric management of adults diagnosed with bipolar disorder, accompanied by a decrease in the use of lithium and other mood stabilizers.”

Finally, in the third selection, Dr. Zheala Qayyum (of the US Army) considers her time working in New York City during the pandemic. “The first thing that struck me when I stepped into the hospital in Queens was the smell that hung in the air, in these seemingly sterile hospital corridors. It was death and disease.”

DG

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Reading of the Week: What Now? CJP on Mental Health of Communities; also, Telepsychiatry Post-COVID (JAMA Psych), and Gold on Stigma (Time)

From the Editor

What now? COVID is part of our new reality. But as we move forward – as a nation that is past peak, and slowly beginning the task of reopening – how do we understand the mental health needs, challenges, and opportunities of the post-pandemic world? This week, we have three selections considering that question.

The first is a new editorial. In The Canadian Journal of Psychiatry, Dr. Daniel Vigo (of the University of British Columbia) and his co-authors note that “epidemics & pandemics have long been known to impact mental health: The mental problems triggered by viral outbreaks have been described as a ‘parallel epidemic.’” Understanding that subpopulations have different needs, they argue for an approach that focuses on those at greater risk. They make specific recommendations in an impressive paper that includes 52 references.

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Will our digital moment continue? In the second selection, we look at a new JAMA Psychiatry paper by Dr. Jay H. Shore (of the University of Colorado) and his co-authors, who argue that it should. They note that many clinics and hospitals have embraced telepsychiatry. He argues that, with the right approach, we could have “a golden era for technology in psychiatry in which we are able to harmonize the benefits of telepsychiatry and virtual care while maintaining the core of our treatment: that of human connectedness.”

Finally, in the third selection, Dr. Jessica Gold (of the University of Washington in St. Louis) considers stigma around mental illness. In this time of COVID, she wonders if it will fade further, providing some evidence from social media. She sees opportunity for better: “Instead of looking at the post-COVID-19 mental health future through a lens of inevitable doom, we can, and should, use this moment as the impetus for the changes that mental health care has always pushed for.”

DG

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Reading of the Week: Physician Burnout, Interrupted (NEJM); also, COVID and Schizophrenia (Schiz Bulletin) and a Reader Responds on Inpatient Care

From the Editor

As we come to understand the new normal – a world of PPEs and precautions – we need to consider not just the implications of the virus on today’s work, but tomorrow’s.

In the first selection, we look at a new paper on physician burnout. In The New England of Journal, Drs. Pamela Hartzband and Jerome Groopman (both of Harvard Medical School) argue that burnout will not be remedied by offers of exercise classes and the other usual prescriptions. Drawing on organizational psychology, they call for a fundamentally different approach, built on autonomy, competence, and relatedness. At a time of COVID, “health care professionals are responding with an astounding display of selflessness, caring for patients despite the risk of profound personal harm. Our efforts are recognized and applauded.” Now, they argue, is the moment for action.

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Are people with schizophrenia at particular risk during this pandemic? In the second selection, we consider a new Schizophrenia Bulletin paper by Dr. Nicole Kozloff (of the University of Toronto) and her co-authors, who answer this question with a convincing yes. “We suggest that thoughtful consideration of the implications of COVID-19 for people with schizophrenia may not only reduce the burden of the global pandemic on people with schizophrenia, but also on the population as a whole.” They offer recommendations.

Finally, in the third selection, a reader responds to last week’s Reading. Rachel Cooper (of the University of Toronto) considers the inpatient experience. “Those of us who have spent time on psychiatric units, particularly while on forms (or held involuntarily), can speak to the immense isolation and feelings of violation of having our basic liberties removed. In this time of COVID, those with the privilege of not having had the experience of being in hospital involuntarily are getting a small taste of that isolation.”

Please note that there will be no Reading next week.

DG

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Reading of the Week: COVID & Mental Health Access in China (AJP); also, Transformational Care (EBMH) and Psych Wards (New Yorker)

From the Editor

What’s the latest in the literature on COVID and mental health? This week, we focus again on the pandemic with three selections.

In the first, we consider a paper on mental health services at a Chinese hospital during the pandemic. In this American Journal of Psychiatry study, Dr. Junying Zhou (of Sichuan University) and co-authors report on a survey of existing and new outpatients, finding major problems with access. Among the findings: one in five found that their mental health had deteriorated due to a lack of access to care. The authors advocate further study to “ameliorate the negative impact of viral outbreaks in the general public, especially among those vulnerable patients with mental problems.”

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Will COVID change health care once the virus has burned out? In the second selection, we consider a new EBMH editorial by Dr. Katharine Smith (of Oxford University) and her co-authors. They write: “In order to reappraise effectively our new ways of working, both in the immediate management of issues during the pandemic and also during the longer-term aftermath, we need fast-track implementation of evidence-based medicine techniques in mental health to supply the best evidence to clinicians on specific questions in real time.”

Finally, in the third selection, we look at an essay from The New Yorker. Reporter Masha Gessen argues that psychiatric wards are particularly vulnerable during the pandemic. Gessen speaks to several doctors who offer a similar if haunting story: “how a lack of testing, P.P.E., and seclusion protocols were making a difficult task – maintaining the safety of a highly vulnerable population and their care workers during a pandemic – virtually impossible.”

DG

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Reading of the Week: COVID & Mental Health (NEJM); also, Helping Health Workers (CMAJ) and Caring Contact for the Elderly (Globe)

From the Editor

This week’s Reading – like the last few – focuses on the latest in the literature on COVID and mental health care with three selections. As life with the pandemic continues, more and more journals have published about it, with some discussing the implications for mental health services.

In the first selection, we consider a paper on mental health services and the pandemic. In a NEJM paper, Drs. Betty Pfefferbaum (of University of Oklahoma Health Sciences Center) and Carol S. North (University of Texas Southwestern Medical Center) argue for an integrated and measured approach. In responding to COVID, they advocate that: “already stretched health care providers have an important role in monitoring psychosocial needs and delivering psychosocial support to their patients, health care providers, and the public – activities that should be integrated into general pandemic health care.”

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How can we help health workers? In the second selection, we consider a new CMAJ paper by Dr. Peter E. Wu (of the University of Toronto)and co-authors. They write: “Taking care of ourselves is vital so that we may continue to take care of others.”

Finally, in the third selection, we look at a news article from The Globe and Mail. Reporter Erin Anderssen describes how “caring contacts,” a psychiatric intervention, is used by volunteers to connect with the elderly. “The spontaneous initiatives expanding now are prompted more by what we instinctively know: Human contact motivated purely by compassion is essential to our well-being.”

DG

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Reading of the Week: COVID & Suicide (JAMA Psych); also, Digital Mental Health (JMIR) and Solomon on COVID & Depression (NYT)

From the Editor

Will suicide rates rise with COVID? How will mental health care delivery change? Are we overlooking the most vulnerable?

This week’s Reading will focus on the latest in the literature on the COVID and mental health care, with three selections.

In the first, we consider a paper on COVID and suicide. In a JAMA Psychiatry paper, Mark A. Reger (of University of Washington) and his co-authors consider the impact of the global emergency on suicide. They are practical, and explain that there are clear opportunities for suicide prevention. In responding to COVID, they call for a “comprehensive approach that considers multiple US public health priorities, including suicide prevention.”

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What is the role of digital mental health during and after this pandemic? In the second selection, we consider a new JMIR Mental Health paper. Dr. John Torous (of Harvard University) and his co-authors note the greater use of telemental health, apps, and other forms of e-mental health care. They write: “The COVID-19 crisis and global pandemic may be the defining moment for digital mental health, but what that definition will be remains unknown.”

Finally, in the third selection, we look at an essay by Andrew Solomon. The Pulitzer Prize-finalist author discusses pandemic and mental health, worrying that those in need may be overlooked. “When everyone else is experiencing depression and anxiety, real, clinical mental illness can get erased.”

DG

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Reading of the Week: COVID & Serious Mental Illness (JAMA Psych); also, Mental Health Care (Lancet Psych) and Hospital Care (Neurosci Bull)

From the Editor

In a heavy moment, a colleague of mine observed that spring is finally here, but none of us can enjoy it. This comment is one of many made over these past weeks about our new life. Our businesses are closed; our elderly are hiding; our colleagues are on the front lines and at risk. And, yes, the simple pleasure of enjoying a spring day – the warmth in the air, the song of the birds – has been lost, at least for now.

This week’s Reading has three selections, and each touches on the intersection between the pandemic and mental health care. Our new life means new challenges as we attempt to deliver mental health care services.

In the first selection, we consider a paper on COVID and serious mental illness. In a JAMA Psychiatry paper, Dr. Benjamin G. Druss (of Emory University) writes: “Disasters disproportionately affect poor and vulnerable populations, and patients with serious mental illness may be among the hardest hit.”

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What is the role of mental health care during this pandemic? In the second selection, we consider a new Lancet Psychiatry editorial. The editors write: “Although the mental health field’s interest in trauma has greatly expanded in recent decades, our scientific understanding of trauma has lagged far behind, including our understanding of its definition and aetiology, and, importantly, of how to effectively intervene.”

Finally, in the third selection, we look at a letter by Dr. Yuncheng Zhu (of Shanghai Jiao Tong University School of Medicine) and his co-authors. They discuss inpatient care and the risk and prevention of infection. “Panic is inevitable among patients and medical staff and timely mental health care for dealing with the novel coronavirus outbreak is urgently needed.”

DG

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Reading of the Week: Exposure to COVID & Mental Health (JAMA Netw Open); Also, the Psych Impact of Quarantine (Lancet) and Inspiring Docs (NYT)

From the Editor

We read often about the physical health effects of COVID. But how does this pandemic affect mental health?

This week’s Reading has three selections, with two focused on this question.

In the first selection, we consider the psychological effects of COVID on health care workers. In a new JAMA Network Open paper, Jianbo Lai (of Zhejiang University School of Medicine) and co-authors look at mental health outcomes and the factors associated with them in China. “Among Chinese health care workers exposed to COVID-19, women, nurses, those in Wuhan, and front-line health care workers have a high risk of developing unfavorable mental health outcomes and may need psychological support or interventions.”

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During this pandemic, many Canadians are self-isolating; in the coming weeks, many could be quarantined. In the second selection, we consider a new Lancet paper on quarantine and its psychological impact. Samantha K. Brooks (of King’s College London) and her co-authors write: “Given the developing situation with coronavirus, policy makers urgently need evidence synthesis to produce guidance for the public. In circumstances such as these, rapid reviews are recommended by WHO.”

Finally, in the third selection, we look at a NYT essay by Dr. Donald Berwick (of Harvard Medical School). He discusses the way health care providers have risen to the challenge of COVID. “We are witnessing professionalism in its highest form, skilled people putting the interests of those they serve above their own interests.”

DG

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